<?=$this->load->view('include_header',null)?>
	<div id="top-panel">
		<div id="panel">
			<ul>
				<li class="current"><a href="<?=site_url('archive/idcard/'.$id)?>" class="report"><?=(empty($id))?"录入新":"编辑"?>客户基本信息</a></li>
				<?php if(!empty($info->id)):?><li><a id="printInfo" class="folder_table">打印本页信息</a></li><?php endif;?>
			</ul>
		</div>
	</div>
	<div id="wrapper">
		<div id="content">
			<div id="box">
<!-- table begin -->
<form method="post" id="form"  enctype="multipart/form-data" action="<?=site_url('schengen/de_student_update/'.$cateid)?>">

	<h3>德国学生签证</h3>
    <table width="100%">
    <thead>
        <tr>
          <td colspan="4" align="right"><img src="<?= (@$info->avatar)?@$info->avatar:'images/avatar.gif'?>" width="150" height="150" /></td>
		  <td align="right">
		  上传照片<br />
		  <input type="file" name="userphoto" /><br />
		  (.gif|.jpg|.png文件,最大1M)<br />
		  <?php if (@$info->attachment):?><a href="<?= @$info->attachment?>" target="_blank">点击下载附件</a><?php endif; ?>
		  &nbsp;&nbsp;&nbsp;&nbsp;上传附件<br />
		  <input type="file" name="userfile" /><br />
		  (.pdf|.zip|.rar|.doc,最大2M)		  
		  </td>
        </tr>
    </thead>
    <tfoot>
        <tr>
            <td colspan="5" align="right">			
			<input type="hidden" name="id" value="<?=$id?>" />
			<input id="button1" type="submit" value="提交信息" />
			<input id="button2" type="reset" value="重置" />
			</td>
        </tr>
    </tfoot>

    <tbody>
        <tr class="odd">
            <td colspan="2">1.<strong> Familienname<br />
            </strong>Family  name / Nom de famille / Cognome</td>
            <td colspan="3"><input name="surname" type="text" value="<?= @$info->surname?>" /></td>
        </tr>
        <tr class="even">
            <td colspan="2"><strong>bei Frauen:  Geburtsname<br />
            </strong>
              Women state maiden  name / Pour les femmes mariées: nom de jeune ﬁlle / Per donne: cognome da ragazza 
              </td>
            <td colspan="3"><input name="former" type="text" value="<?= @$info->former?>" /></td>
        </tr>
        <tr class="odd">
            <td colspan="2">2.<strong> Vornamen</strong><br />
              Given  names / Prénoms / Nomi</td>
            <td colspan="3"><input type="text" name="firstname" value="<?= @$info->firstname?>" /></td>
        </tr>
        <tr class="even">
            <td colspan="2">3. <strong>Geburtstag
            </strong><br />
            Date  of birth / Date de naissance / Data di nascita</td>
            <td colspan="3"><input type="text" name="birth" value="<?= @$info->birth?>" id="birth" /></td>
        </tr>
        <tr class="odd">
            <td colspan="2">4. <strong>Geburtsort </strong><br />
Place of birth / Lieu de  naissance / Luogo di nascita</td>
            <td colspan="3"><input type="text" name="birth_place" value="<?= @$info->birth_place?>" /></td>
        </tr>
        <tr class="even">
           <td colspan="2">5. <strong>Staatsangehörigkeit(en) </strong><br />
             Nationality /  Nationalité(s) / Cittadinanza(e)<br />
             <strong>bei mehreren Staatsangehörigkeiten sind alle anzugeben.
             </strong><br />(If more than one, each should be stated) / (indiquer toutes les nationalités s'il y en a plusieurs) / (in caso di più citta-
dinanze indicarle tutte)
</td>
            <td colspan="3">a) <strong>jetzige </strong>present / actuelle / attuale 
              <input type="text" name="nationality" value="<?= @$info->nationality?>" />
              <br />
              b) <strong>fruhere </strong>former / precedente /  precedente 
              <input type="text" name="ori_nationality" value="<?= @$info->ori_nationality?>" /></td>
        </tr>
        <tr class="odd">
            <td><strong>6. Familienstand</strong> <br/>
Personal Status/ Situation de famille / Stato civile</td>
            <td colspan="4">
<input type="radio" name="marital_status" value="1" <?= (@$info->marital_status==1)?'checked':''?>/>
Ledig (Single / Célibataire / Celibe-nubile)<br />
<input type="radio" name="marital_status" value="2" <?= (@$info->marital_status==2)?'checked':''?>/>
verheiratet (married / marié(e) / sposato(a) ) seit (since / depuis / dal) 
<input type="text" name="married_since" value="<?= @$info->married_since?>" />
<br />
<input type="radio" name="marital_status" value="3" <?= (@$info->marital_status==3)?'checked':''?>/>
geschieden (divorced / divorcé(e) / divorziato(a))<br />
<input type="radio" name="marital_status" value="4" <?= (@$info->marital_status==4)?'checked':''?>/>
              verwitwet (widowed / veuf (veuve) / vedovo(a)) </td>
        </tr>
        <tr class="even">
           <td colspan="2">7.<strong> Ehegatte *) Name</strong><br />
             Spouse*)  - Name / Epoux*) - Nom / Coniuge*) - Cognome</td>
            <td colspan="3"><input type="text" name="spouse_surname" value="<?= @$info->spouse_surname?>" /></td>
        </tr>
        <tr class="odd">
           <td colspan="2"><strong>Geburtsname </strong>(bei Frauen)<br />
             (Maiden name) - Nom de  jeune ﬁlle (pour femmes) / Cognome da ragazza (per  donne)</td>
            <td colspan="3"><input type="text" name="spouse_former" value="<?= @$info->spouse_former?>" /></td>
        </tr>
        <tr class="even">
            <td colspan="2"><strong>Vornamen</strong><br />
              Given  names / Prénoms / Nomi</td>
            <td colspan="3"><input type="text" name="spouse_firstname" value="<?= @$info->spouse_firstname?>" /></td>
        </tr>
		        <tr class="odd">
            <td colspan="2"><strong>Geburtstag</strong><br />
              Date  of birth / Date de naissance / Data di nascita</td>
            <td colspan="3"><input type="text" name="spouse_birth" value="<?= @$info->spouse_birth?>" id="spouse_birth" /></td>
        </tr>
        <tr class="even">
            <td colspan="2"><strong>Geburtsort</strong><br />
              Place of birth - Lieu de  naissance / Luogo di nascita</td>
            <td colspan="3"><input type="text" name="spouse_birth_place" value="<?= @$info->spouse_birth_place?>" /></td>
        </tr>		
        <tr class="odd">
            <td colspan="2"><strong>Staatsangehörigkeit</strong><br />
              Nationality /  Nationalité / Cittadinanza</td>
            <td colspan="3"><input type="text" name="spouse_nationality" value="<?= @$info->spouse_nationality?>" /></td>
        </tr>
        <tr class="even">
            <td colspan="2"><strong>Wohnort</strong><br />
              Residence  / Domicile / Abitazione</td>
            <td colspan="3"><input type="text" name="spouse_residence" value="<?= @$info->spouse_residence?>" /></td>
        </tr>

  <tr>
	<td>8. <strong>Kinder*) Name</strong><br />Children*) - Name<br />Enfants*) -Nom<br />Figli*) - Cognome</td>
	<td><strong>Vornamen</strong><br />Given names<br />
	  Prénoms<br />
	  Nomi</td>
	<td><strong>Geburtstag und -ort</strong>
	  <br />Date / Place of birth<br />Date /Lieu de naissance<br />
	  Data Luogo di nascita</td>
	<td><strong>Staatsangehörigkeit</strong><br />
	  Nationality<br />
	  Nationalité<br />
	  Cittadinanza</td>
	<td><strong>Wohnort</strong><br />
	  Residence<br />Domicile<br />
	  Abitazione</td>
  </tr>
  <tr>
	<td><input type="text" name="child1_surname" value="<?= @$info->child1_surname?>" /></td>
	<td><input type="text" name="child1_firstname" value="<?= @$info->child1_firstname?>" /></td>
	<td><input type="text" name="child1_birth" value="<?= @$info->child1_birth?>" /></td>
	<td><input type="text" name="child1_nationality" value="<?= @$info->child1_nationality?>" /></td>
	<td><input type="text" name="child1_residence" value="<?= @$info->child1_residence?>" /></td>
  </tr>
  <tr>
	<td><input type="text" name="child2_surname" value="<?= @$info->child2_surname?>" /></td>
	<td><input type="text" name="child2_firstname" value="<?= @$info->child2_firstname?>" /></td>
	<td><input type="text" name="child2_birth" value="<?= @$info->child2_birth?>" /></td>
	<td><input type="text" name="child2_nationality" value="<?= @$info->child2_nationality?>" /></td>
	<td><input type="text" name="child2_residence" value="<?= @$info->child2_residence?>" /></td>
  </tr>
  <tr>
	<td><input type="text" name="child3_surname" value="<?= @$info->child3_surname?>" /></td>
	<td><input type="text" name="child3_firstname" value="<?= @$info->child3_firstname?>" /></td>
	<td><input type="text" name="child3_birth" value="<?= @$info->child3_birth?>" /></td>
	<td><input type="text" name="child3_nationality" value="<?= @$info->child3_nationality?>" /></td>
	<td><input type="text" name="child3_residence" value="<?= @$info->child3_residence?>" /></td>
  </tr>
  <tr>
	<td><input type="text" name="child4_surname" value="<?= @$info->child4_surname?>" /></td>
	<td><input type="text" name="child4_firstname" value="<?= @$info->child4_firstname?>" /></td>
	<td><input type="text" name="child4_birth" value="<?= @$info->child4_birth?>" /></td>
	<td><input type="text" name="child4_nationality" value="<?= @$info->child4_nationality?>" /></td>
	<td><input type="text" name="child4_residence" value="<?= @$info->child4_residence?>" /></td>
  </tr>
  <tr>
	<td><input type="text" name="child5_surname" value="<?= @$info->child5_surname?>" /></td>
	<td><input type="text" name="child5_firstname" value="<?= @$info->child5_firstname?>" /></td>
	<td><input type="text" name="child5_birth" value="<?= @$info->child5_birth?>" /></td>
	<td><input type="text" name="child5_nationality" value="<?= @$info->child5_nationality?>" /></td>
	<td><input type="text" name="child5_residence" value="<?= @$info->child5_residence?>" /></td>
  </tr>
  <tr>
	<td><input type="text" name="child6_surname" value="<?= @$info->child6_surname?>" /></td>
	<td><input type="text" name="child6_firstname" value="<?= @$info->child6_firstname?>" /></td>
	<td><input type="text" name="child6_birth" value="<?= @$info->child6_birth?>" /></td>
	<td><input type="text" name="child6_nationality" value="<?= @$info->child6_nationality?>" /></td>
	<td><input type="text" name="child6_residence" value="<?= @$info->child6_residence?>" /></td>
  </tr>

        <tr class="even">
            <td colspan="5"><strong>*) Angaben sind auch erforderlich, wenn diese Personen im  Ausland verbleiben. </strong> <br />
              *) This information is also required if  the person concerned remains abroad.<br />
              *) Renseignements  indispensables, même si ces personnes demeurent à l’étranger. 
              <br />
              *) Indicazioni occorenti anche se queste persone  rimangono all’estero. </td>
        </tr>

        <tr class="odd">
            <td colspan="2"><strong>9. Vater*) </strong>(des  Antragstellers) <strong>– Name</strong><br />
              Father*) (of the applicant) – Family name / Père*) (du requérant) – Nom / Padre*) (del richiedente) – Cognome
</td>
            <td colspan="3"><input type="text" name="father_surname" value="<?= @$info->father_surname?>" /></td>
        </tr>
        <tr class="even">
            <td colspan="2"><strong>Vornamen</strong><br />
              Given names / Prénoms /  Nomi</td>
            <td colspan="3"><input type="text" name="father_firstname" value="<?= @$info->father_firstname?>" /></td>
        </tr>
        <tr class="odd">
            <td colspan="2"><strong>10. Mutter*) </strong>(des  Antragstellers) – <strong>Name Geburtsname</strong><br />
              Mother*) (of the applicant ) – Family name / Mere*) (du requérant) – Nom / Madre*) (del richiedente) – Cognome</td>
            <td colspan="3"><input type="text" name="mother_surname" value="<?= @$info->mother_surname?>" /></td>
        </tr>
        <tr class="even">
            <td colspan="2"><strong>Vornamen</strong><br />
              Given names / Prénoms /  Nomi</td>
            <td colspan="3"><input type="text" name="mother_firstname" value="<?= @$info->mother_firstname?>" /></td>
        </tr>
        <tr class="odd">
             <td colspan="2"><strong>11. Pass oder sonstiger Reiseausweis – Genaue Bezeichnung</strong><br />
              Passport or other travel document / Passeport ou autre certiﬁcat de voyage/ Passaporto oppure altro documento di viaggio</td>
             <td colspan="3"><strong>Nr.</strong> ( No. / N° / N° ) 
               <input type="text" name="travel_document_num" value="<?= @$info->travel_document_num?>" />
              <br />
              <strong>gültig bis </strong>( Valid until – valable jusqu’au / valevole ﬁno  al ) 
              <input type="text" name="travel_document_valid_date" value="<?= @$info->travel_document_valid_date?>" id="travel_document_valid_date" />
              <br />
              <strong>ausgestellt von</strong> ( issued by – délivré par / emesso da ) 
              <input type="text" name="travel_document_issue_by" value="<?= @$info->travel_document_issue_by?>" />
              <br />
              <strong>ausgestellt am</strong> (issued on – établi le / rilasciato il ) 
              <input type="text" name="travel_document_issue_date" value="<?= @$info->travel_document_issue_date?>" id="travel_document_issue_date" /></td>
        </tr>
        <tr class="even">
             <td colspan="2"><strong>12. Rückkehrberechtigung (falls im PaB vermerkt) nach
</strong><br />
              Authorization to return to(if entered in passport)/
Autorisation de retour en(s’il en est fair mention dans
Le passport / Autorizzazione di ritorno a (se registrato
Nel passport)
</td>
            <td colspan="3"><input type="text" name="txt_12_1" value="<?= @$info->txt_12_1?>" style="width:300px"/>
              <br />
              <strong>bis  zum</strong> ( Until / jusqu au / fino al ) 
              <input type="text" name="txt_12_2" value="<?= @$info->txt_12_2?>" /></td>
        </tr>
        <tr class="odd">
             <td colspan="2"><strong>13. Eingereist am*)</strong><br />
              Entered Gemany on ** / Date d’entrée en Allemagne**/
Entrato in Gemania il **
</td>
            <td colspan="3"><input type="text" name="txt_13" value="<?= @$info->txt_13?>" style="width:300px" /></td>
        </tr>
        <tr class="even">
            <td colspan="2"><strong>14.	Haben Sie sich bereits früher in Deutschland aufgehalten?</strong><br />
Have you ever stayed in Germany before? / Avez-vous déjà séjourné précédemment en Allemagne? / Ha già soggiornato 
precedentemente in Germania?</td>
            <td colspan="3"><input type="radio" name="is_14" value="1" <?= (@$info->is_14==1)?'checked':''?>/>
              <strong>ja</strong> ( yes / oui / si )
              <input type="radio" name="is_14" value="0" <?= (@$info->is_14==0)?'checked':''?>/>
              <strong>nein</strong> ( no / non /no) </td>
        </tr>
        <tr class="odd">
           <td colspan="5"><strong>Wenn ja, Angabe der Zeiten und Wohnorte</strong><br />
              lf so, enter dates und places / Si oui, indiquez les 
dates et les domiciles / In caso affermativo, indicare 
i periodi e i luoghi residenza<br/>

<strong>von</strong> ( from / du / dal )<strong>
<input type="text" name="txt_14_1_1" value="<?= @$info->txt_14_1_1?>"/>
bis</strong> ( to / au / al )<strong>
<input type="text" name="txt_14_1_2" value="<?= @$info->txt_14_1_2?>"/>
in </strong>( in/ a / a )<strong>
<input type="text" name="txt_14_1_3" value="<?= @$info->txt_14_1_3?>"/>
<br />
von</strong> ( from / du / dal )<strong>
<input type="text" name="txt_14_2_1" value="<?= @$info->txt_14_2_1?>"/>
bis</strong> ( to / au / al )<strong>
<input type="text" name="txt_14_2_2" value="<?= @$info->txt_14_2_2?>"/>
in </strong>( in/ a / a )<strong>
<input type="text" name="txt_14_2_3" value="<?= @$info->txt_14_2_3?>"/>
<br />
von</strong> ( from / du / dal )<strong>
<input type="text" name="txt_14_3_1" value="<?= @$info->txt_14_3_1?>"/>
bis</strong> ( to / au / al )<strong>
<input type="text" name="txt_14_3_2" value="<?= @$info->txt_14_3_2?>"/>
in </strong>( in/ a / a )<strong>
<input type="text" name="txt_14_3_3" value="<?= @$info->txt_14_3_3?>"/>
</strong></td>
            
        </tr>
        <tr class="even">
            <td colspan="2"><strong>15.	Vorgesehener Aufenthaltsort(ggf. Anschrift)
in der Bundescrepublik Deutschland
</strong><br />
              Proposed place of residence in the Federal Republic of 
Germany (address) / Lieu de residence prevu en Republique
Federale d’Allemagne (adresse) / Soggiorno previsto nella
Repubblica Federale di Germania (eventualmente indirizzo)

</td>
            <td colspan="3"><input name="txt_15" type="text" value="<?= @$info->txt_15?>" style="width:300px" /></td>
        </tr>
        <tr class="odd">
            <td colspan="2"><strong>16.	Zugezogen ** ) – am</strong><br />
             Arrived on**) / Date d’etablissement au lieu de
Residence**) le / Arrivato
**) il</td>
            <td colspan="3"><input type="text" name="txt_16_1" value="<?= @$info->txt_16_1?>" style="width:300px" />
              <br />
              <strong>VON</strong> (From / venant de / da) 
              <input type="text" name="txt_16_2" value="<?= @$info->txt_16_2?>" /></td>
        </tr>
        <tr class="even">
            <td colspan="2"><strong>17.	Wird ständiger Wohnort außerhalb der Bundesrepublik Deutschland beibehalten und ggf. wo?</strong><br />
Do you intend to maintain your permanent residence out-
side the Federal Republic of Germany? lf so, where? / 
Conservez-vous un domicile permanent en dehors de la 
République fédérale d’Allemagne et, le cas échéant, où? / 
Mantiene la residenza permanente al di fuori dalla Re-
pubblica Federale di Gemania, in caso affermativo, dove?
</td>
            <td colspan="3"><input type="radio" name="is_17" value="1" <?= (@$info->is_17==1)?'checked':''?>/>
              <strong>ja</strong> ( yes / oui / si )  <input type="text" name="txt_17" value="<?= @$info->txt_17?>" style="width:300px" />
              <br />
              <input type="radio" name="is_17" value="0" <?= (@$info->is_17==0)?'checked':''?>/>
              <strong>nein</strong> ( no / non /no) </td>
        </tr>
        <tr class="odd">
            <td colspan="2"><strong>18.	Sollen Familienangehörige mit eingereist?***)</strong><br />
Wil you be accompanied by members of you family?***) /
Les members de la famille doivent-ils venir aussi? ***) /
Lei e accompagnato da familiari ? ***)
  <br />
  <strong>Wenn ja, welche?</strong><br />If so, which? / Dans l’affirmative, de quelles personnes
S’agit-il ? / In caso affermativo, da quali ?
</td>
            <td colspan="3"><input type="radio" name="is_18" value="1" <?= (@$info->is_18==1)?'checked':''?>/>
              <strong>ja</strong> ( yes / oui / si )  <input type="text" name="txt_18" value="<?= @$info->txt_18?>" style="width:300px"/>
              <br />
              <input type="radio" name="is_18" value="0" <?= (@$info->is_18==0)?'checked':''?>/>
              <strong>nein</strong> ( no / non /no) </td>
        </tr>
        <tr class="even">
            <td colspan="2"><strong>19.	Wie sind Sie wohnungsmäßig untergebracht?</strong><br />
             How are you accommodated? **) / Comment etes-vous
Loge ? ** / Come e alloggiato? **
            </td>
            <td colspan="3">
			  <input type="radio" name="is_19" value="1" <?= (@$info->is_19==1)?'checked':''?>/>
              <strong>Einzelzimmer</strong> ( Single room / Chambre individuelle / Camera singola ) <br />
              <input type="radio" name="is_19" value="2" <?= (@$info->is_19==2)?'checked':''?>/>
              <strong>Sammelunterkunft</strong> ( Collective accomodation / Logement collectif / Alloggio collettivo) <br />
              <input type="radio" name="is_19" value="3" <?= (@$info->is_19==3)?'checked':''?>/>
              <strong>Wohnung mit Zimmer</strong>
              <input name="txt_19" type="text" value="<?= @$info->txt_19?>" style="width:80px"/>
              <strong>Zimmer</strong> ( Dwelling with………rooms / <br />
              Appartment de..........pieces / Appartamento con..........camere) </td>
        </tr>
        <tr class="odd">
           <td colspan="2"><strong>20. Zweck des Aufenthalts in der Bundesrepublik Deutschland</strong><br />
             Purpose of stay in the Federal Republic of Germany /
Objet du sejour en Republique federale d’Allemagne /
Scopo del soggiorno nella Repubblica Federale di Germania
</td>
            <td colspan="3"><strong>(z. B. Besuch,  Touristenreise, Studium, Arbeits-aufnahme usw. </strong><br />
              (E.g. visit, holiday,  study. Employment, etc. / (p. ex. Visite,  voyage de tourisme, etudes, travail, etc.<br /> 
              / (ad es. Visita, viaggio turistico,  studio, lavoro ecc.<br />
              <input name="txt_20_1" type="text" value="<?= @$info->txt_20_1?>" style="width:300px"/></td>
        </tr>
        <tr class="even">
           <td colspan="2"><strong>Arbeitgeber</strong><br />
             Employer / employeur / datore di lavoro</td>
            <td colspan="3"><input type="text" name="txt_20_2" value="<?= @$info->txt_20_2?>" style="width:300px" /></td>
        </tr>
        <tr class="odd">
            <td colspan="2"><strong>Name der  Verwandten, der Studienanstalt, Referenzen usw.)</strong>
             <br/>Names of relatives, educational establishment, references, etc. ) / Nom de parents, de l’etablissement d’enseignement, reference, etc.) / Nome dei parenti, dell’istituto, referenze ecc. ) </td>
            <td colspan="3">
              <textarea name="txt_20_3"><?= @$info->txt_20_3?></textarea>
            </td>
        </tr>
        <tr class="even">
             <td colspan="2"><strong>Deren Anschrift</strong>
             <br/>
             Their addresses / leur adresse / indirizzo</td>
            <td colspan="3"><textarea name="txt_20_4"><?= @$info->txt_20_4?></textarea></td>
        </tr>
        <tr class="odd">
             <td colspan="2"><strong>Beabsichtigte Erwerbstätigkeit Angabe des auszuubenden Berufs</strong>
             <br/>Intended employment(occupation to be excercised) / Activite 
envisagee ( Designation de la profession exercee) / Impiego 
prvisto (indicate il mestiere da svolgere)</td>
            <td colspan="3"><textarea name="txt_20_5"><?= @$info->txt_20_5?></textarea></td>
        </tr>
		
		<tr class="even">
           <td colspan="2"><strong>21. Erlernter Beruf</strong><br />
             Trade or profession for which trained / profession apprise / Mestiere imparato</td>
            <td colspan="3"><textarea name="txt_21"><?= @$info->txt_21?></textarea></td>
		</tr>
		
		<tr class="odd">
           <td colspan="2"><strong>22.	Haben Sie bereits eine Erlaubnis der deutschen Arbeitsverwaltung?</strong><br />
             Are you alreday in possession of a permit issued by a German labour office? / Etes-vous deja en possession d’une autorisation de l’administration allemande du travail? / Ha gia un permesso dell’amministrazione tedesca di lavoro?</td>
            <td colspan="3"><input type="radio" name="is_22" value="1" <?= (@$info->is_22==1)?'checked':''?>/>
              <strong>ja</strong> ( yes / oui / si )
              <input type="radio" name="is_22" value="0" <?= (@$info->is_22==0)?'checked':''?>/>
              <strong>nein</strong> ( no / non /no) <br />
              <strong>Zusicherung der – Arbeitserlaubnis / Legitimationskarte <br />
              </strong>Labour permit / legitimation card assured / Garantie de l’autorisation de travail/ carte de legitimation<br />
              / Garanzia del- permesso di lavoro / carta di legitimazione<br />
              <input name="txt_22" type="text" value="<?= @$info->txt_22?>" style="width:300px"/>              </td>
		</tr>
		
		<tr class="even">
           <td colspan="2"><strong>23.	Beabsichtigte Dauer des Aufenthalts in der Bundesrepublik Deutschlan</strong><br />
            Intended duration of stay in the Federal Republic of Germany / Duree probable du sejour en Republique federale d’Allemagne / Durata prevista del soggiorno nella Repubblica Federale di Germania</td>
            <td colspan="3"><strong>vom</strong> ( from /  du / dal ) 
              <input type="text" name="txt_23_1" value="<?= @$info->txt_23_1?>" />
              <br />
              <strong>bis</strong> ( to /  au / al ) 
              <input type="text" name="txt_23_2" value="<?= @$info->txt_23_2?>" /></td>
		</tr>
		
		<tr class="odd">
           <td colspan="2"><strong>24.	Aus welchen Mitteln wird der Lebensunterhalt bestritten</strong><br />
             What are your means of subsistence? / Quels sont vos moyens de subsistance? Con quali mezzi fa fronte al sostentamento?</td>
            <td colspan="3"><input name="txt_24" type="text" value="<?= @$info->txt_24?>" style="width:300px"/></td>
        </tr>
		
		<tr class="even">
           <td colspan="2"><strong>25. Sind Sie vorbestraft ?</strong><br />
             Have you ever been convicted ? / Avez-vous des antecedents
Judiciaires? / Ha gia subito condanne?
</td>
            <td colspan="3">
			<input type="radio" name="is_25" value="1" <?= (@$info->is_25==1)?'checked':''?>/>
              <strong>ja</strong> ( yes / oui / si )
              <input type="radio" name="is_25" value="0" <?= (@$info->is_25==0)?'checked':''?>/>
              <strong>nein</strong> ( no / non /no) <br />
              <strong>a) in Deutschland</strong> ( In Germany / en Allemagne / in Germania ) <br />
              <strong>Wann und wo? </strong>( When and where? Quand et ou? Quando e dove? ) <br />
              <input name="txt_25_1" type="text" value="<?= @$info->txt_25_1?>" style="width:300px" />
              <br />
              <strong>Grund der Strafe  </strong>( For what reason / Motif de la peine encourue / Motivo della condanna )<br />
              <input name="txt_25_2" type="text" value="<?= @$info->txt_25_2?>" style="width:300px" />
              <br />
              <strong>Art und Hobe der Strafe </strong>( Nature and extent of the penalty / Nature et importance de la peine <br />
              / Tipo ed entita della condanna) 
              <input name="txt_25_3" type="text" value="<?= @$info->txt_25_3?>"  style="width:300px" />
              <br />
              <br />
              <strong>b) im Ausland</strong> ( In other countries / a l’  etranger / all’ estero ) <br />
              <strong>Wann und wo? </strong>( When and where? Quand et ou? Quando e dove? ) <br />
              <input name="txt_25_4" type="text" value="<?= @$info->txt_25_4?>" style="width:300px" />
              <br />
              <strong>Grund der Strafe </strong>( For what reason / Motif de la peine encourue / Motivo della condanna )<br />
              <input name="txt_25_5" type="text" value="<?= @$info->txt_25_5?>" style="width:300px" />
              <br />
              <strong>Art und Hobe der Strafe </strong>( Nature and extent of the penalty / Nature et importance de la peine<br /> 
              / Tipo ed entita della condanna)
              <input name="txt_25_6" type="text" value="<?= @$info->txt_25_6?>" style="width:300px" /></td>
		</tr>
		
		<tr class="odd">
           <td colspan="5"><strong>26	Sind Sie aus der Bundesrepublik Deutschland ausgewiesen oder abgeschoben oder ist ein 
Antrag auf Aufenthaltsgenehmigung abgelehnt 
oder eine Einreise in die Bundesrepublik 
Deutschland verweigert worden?
</strong><br />
            Have you been expelled or deported from the Federal Republic of Germany, had an application for a residence permit rejected, or been refused entry into the Federal Republic of Germany 
Avez-vous été expulsé de la République fédérale d’Allemagne ou refoulé ou une demande de permission de séjour vous a-t-elle été refusée ou un voyage en République fédérale d’Allemagne interdit? 
Lei é stato espulso oppure rimpatriato dalla Repubblica Federale di Germania o é stata riﬁutata la sua richiesta die un permesso di soggiorno o é stata negata l’entrata nella Repubblica Federale di Germania? 
            <br />
            <textarea name="txt_26"><?= @$info->txt_26?></textarea></td>
        </tr>
		
		<tr class="even">
           <td colspan="5"><strong>27. a) Leiden Sie an Krankheiten?</strong><br />
             Do you suffer from any diseases? Etes-vous atteini(e) de maladies? / Soffre di malattie ? 
               &nbsp;&nbsp;&nbsp; <input type="radio" name="is_27_1" value="1" <?= (@$info->is_27_1==1)?'checked':''?>/>
               <strong>ja</strong> ( yes / oui / si )
               <input type="radio" name="is_27_1" value="0" <?= (@$info->is_27_1==0)?'checked':''?>/>
               <strong>nein</strong> ( no / non /no) <br />
              <strong>Ggf. an welchen?</strong><br />
              If so, which? Dans l’affirmative, desquelles? In caso  affermativo, di quali? 
              <input name="txt_27" type="text" value="<?= @$info->txt_27?>" style="width:300px" />
              <br />
              <br />
              <strong>b) Besteht  Krankenversicherungsschutz fur die Bundesrepublik Deutschland?</strong><br/>
			  Do you have health insurance cover for the Federal Republic of Germany? Avez-vous une assurance maladie pour la Republique federale d’Allemagne? / E’ protetto da una assicurazione- malattia per la Repubblica Federale di Germania ?  
               &nbsp;&nbsp;&nbsp;
               <input type="radio" name="is_27_2" value="1" <?= (@$info->is_27_2==1)?'checked':''?>/>
               <strong>ja</strong> ( yes / oui / si )
               <input type="radio" name="is_27_2" value="0" <?= (@$info->is_27_2==0)?'checked':''?>/>
               <strong>nein</strong> ( no / non /no) </td>
        </tr>
		
		<tr class="odd">
           <td colspan="5"><strong>Falsche oder  unzutreffende Angaben im Antrag haben den Entzug der Aufenthaltserlaubnis zur  Folge.</strong><br/>
             If false or inappropriate information is supplied in  this application, the residence permit will be withdrawn. /Toute reponse  fasusse ou non pertinente entrainera le retrait du permis de sejour. /  Eventuali indicazioni false o non corrette nella domanda comportano il ritiro  del permesso di soggiorno.</td>
        </tr>
		
		<tr class="even">
           <td colspan="5"><strong>Ich beantrage die  Aufenthaltsgenehmigung für 
             <input name="permit_days" type="text" value="<?= @$info->permit_days?>" /> 
             Tage/Monat(e) / Jahr(e).<br />
           </strong>I hereby apply for a residence  permit for…days / month(s) / year(s) &nbsp;&nbsp;&nbsp;Richiedo il permesso di soggiorno per…giorni/ mese(i) / anno(i)<br />
           Je sollicite une autorisation de séjour pour…jours/ mois / an(s)</td>
        </tr>
		
		<tr class="odd">
           <td colspan="5"><strong>Ich versichere, vorstehende  Angaben nach bestem Wissen und Gewissen richtig und vollständig gemacht zu  haben.</strong><strong><br />
           </strong>I declare that to the best of my knowledge the above particulars are correct and complete.
Je certiﬁe que les décIarations ci-dessus ont été faites à bon escient et qu’elles sont exactes et complétes.
Assicuro di aver fornito le precedenti indicazioni in modo esatto e completo secondo mia miglior conoscenza e coscienza.
</td>
        </tr>
    </tbody>
	</table>
<!-- table end -->
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